ABSTRACT
Occupational therapy practitioners have a role in opposing the harmful, discriminatory practice of conversion "therapy" and protecting LGBTQIA+ people. Occupational therapy practitioners should never participate in or promote the principles of conversion "therapy" practices as part of occupational therapy intervention.
Subject(s)
Occupational Therapy , Sexual and Gender Minorities , Humans , Occupational Therapy/ethicsABSTRACT
Introducción: El terapeuta ocupacional interviene en el desempeño ocupacional de lo cotidiano ya sea del individuo o de la colectividad, buscando la participación social. Objetivo: Este estudio identificó y analizó la bioética en la formación del terapeuta ocupacional en Brasil, su importancia en el desarrollo de competencias y habilidades, en las áreas de la salud, asistencia social, educación y cultura, enfrentándose a los dilemas bioéticos que surgen en las relaciones profesionales. Método: Se utilizó la Declaración Universal de Bioética y Derechos Humanos de la UNESCO(DUBDH) como referencia para este análisis. Se incluyeron para este estudio los principios en los que se identificó una relación con los artículos del Código de Ética y Deontología de la Terapia Ocupacional (CEDTO) de Brasil. Por lo tanto, se estudiaron los siguientes artículos 3º, 4º, 5º, 6º, 7º, 8ºl, 9º, 10º, 11º, 12º, 13º, 14º, 15º, 18º y 28º. Resultados: ¿cuales son los resultados? Se ha obtenido un estudio comparativo y exploratorio entre los principios de la DUBDH, descritos en sus artículos, y los artículos del CEDTO con construcción de Tabla de Datos Demostrativos que representan esa correlación. Conclusión: ¿Cuáles son las conclusiones? La discusión analizó la correlación de los artículos de los documentos, esperando que contribuya en el incremento de la Bioética en la formación del terapeuta ocupacional, conduciendo a cambios de actitudes.
Introduction: Occupational therapist intervenes at the problems in the daily occupational performance of the person or the community, seeking social participation. Aim: This study identified and analyzed the Bioethics in the formation of the occupational therapist in Brazil, its importance in the development of competences and abilities in the areas of health, social assistance, education and culture, in the face of the bioethical dilemmas that arise in the professional relationships. Method: The Universal Declaration of Bioethics and Human Rights of UNESCO (DUBDH) was used as reference for this analysis with the Code of Ethics and Deontology of Occupational Therapy (CEDTO) in Brazil. Therefore, the following principles were studied: 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th, 12th, 13th, 14th, 15th, 18th, and 28th. Results: A comparative and exploratory study was obtained between the principles of the DUBDH, described in its articles, and the articles of the CEDTO with the construction of the Demonstrative Data Table that represent this correlation. Conclusion: The discussion analyzed the correlation of the articles in the documents, hoping that it contributes to the increase of the Bioethics in the formation of the occupational therapist, leading to attitudinal changes.
Subject(s)
Humans , Bioethics , Occupational Therapy/ethics , Codes of Ethics , Social Responsibility , Brazil , Comparative Study , Personal Autonomy , Ethical Theory , Human Rights , Informed ConsentABSTRACT
Background: Ethical decision-making is an important aspect of reasoning in occupational therapy practice. However, the process of ethical decision-making within the broader context of reasoning is yet to be clearly explicated.Objective: The purpose of this study was to advance a theoretical understanding of the process by which occupational therapists make ethical decisions in day-to-day practice.Method: A constructivist grounded theory approach was adopted, incorporating in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings and years of experience. Initially, participants nominated as key informants who were able to reflect on their decision-making processes were recruited. Theoretical sampling informed subsequent stages of data collection. Participants were asked to describe their process of ethical decision-making using scenarios from clinical practice. Interview transcripts were analyzed using a systematic process of initial then focused coding, and theoretical categorization to construct a theory regarding the process of ethical decision-making.Findings: An ethical decision-making prism was developed to capture three main processes: Considering the Fundamental Checklist, Consulting Others, and Doing What's Right. Ethical decision-making appeared to be an inductive and dialectical process with the occupational therapist at its core.Conclusion: Study findings advance our understanding of ethical decision-making in day-to-day clinical practice.
Subject(s)
Decision Making/ethics , Occupational Therapists/ethics , Occupational Therapy/ethics , Female , Grounded Theory , Humans , Interviews as Topic , Male , Occupational Therapists/psychology , Problem SolvingABSTRACT
BACKGROUND.: Inaccuracies and conceptual confusion characterize the literature on the values associated with occupational therapy. PURPOSE.: The purpose of this study was to identify values related to occupational therapy, propose definitions for those values, and validate the content of the definitions. METHOD.: A review of the literature ( n = 52) and consultation of occupational therapists ( n = 26) were used to document and define a series of values. The resulting list of values was tested for functionality by occupational therapists ( n = 5) and presented to occupational therapists with ethics expertise ( n = 6) to assess content validity of the value definitions. FINDINGS.: The proposed list presents 33 values with their definitions that the experts considered to be clear and representative of the realities they describe. The results show that the list is considered exhaustive. IMPLICATIONS.: This study identified values that are ideals that can guide occupational therapy practice and support the claims and cultural and ethical competencies of occupational therapists.
DESCRIPTION.: Des imprécisions et des confusions conceptuelles caractérisent les écrits sur les valeurs liées à l'ergothérapie. BUT.: Répertorier des valeurs liées à l'ergothérapie, proposer des énoncés qui les définissent et procéder à leur validation de contenu. MÉTHODOLOGIE.: Une recension des écrits ( n = 52) et la consultation d'ergothérapeutes ( n = 26) ont permis de documenter et de définir une série de valeurs. Le répertoire issu de ces démarches a été soumis à un test de fonctionnalité auprès d'ergothérapeutes ( n = 5), puis présenté à des ergothérapeutes détenant une expertise en éthique ( n = 6) pour en évaluer la validité de contenu des définitions des valeurs. RÉSULTATS.: Le répertoire proposé comprend 33 valeurs suivies de leur définition que les experts ont jugées claires et représentatives des réalités qu'elles désignent. Les résultats montrent que le répertoire est considéré comme exhaustif. CONSÉQUENCES.: Cette étude a permis de répertorier et de définir des valeurs qui constituent des idéaux susceptibles de guider la pratique ergothérapique et de soutenir les revendications ainsi que les compétences culturelles et éthiques des ergothérapeutes.
Subject(s)
Occupational Therapists/standards , Occupational Therapy/standards , Social Values , Attitude of Health Personnel , Clinical Competence , Cultural Competency , Humans , Occupational Therapists/ethics , Occupational Therapy/ethicsABSTRACT
BACKGROUND/AIM: Professionals in health and social care have high workloads and are working with diverse populations in hierarchical and complicated service delivery systems. There is increasing pressure on new graduates because they are expected to be immediately work ready and may not receive adequate support or supervision. It is well known that there can be issues with satisfaction and retention rates of new graduates due to the challenges they experience. Ethical tensions are an unavoidable part of occupational therapy practice and may contribute to unique challenges for new graduates who may not yet have the personal resources to make sense of these independently. New graduate occupational therapy perceptions of ethical tensions have not yet been explored and this study sought to fill this gap. Exploring the ethical tensions experienced by new graduates can inform appropriate policies, procedures, preparedness and standards. METHODS: A qualitative study using narrative enquiry was undertaken in which stories were gathered from eight new graduate occupational therapists who had been working for 6-24 months. Semi-structured in-depth interviews were used to gather data. Transcripts were analysed following narrative analysis guidelines. Member checking, reflexivity and keeping an audit trail of methodological and analytical decisions were employed to strengthen the rigour of the study. RESULTS: Analysis revealed six predominant themes: working in a business model, respecting client choice, dealing with aggression and death, mandatory reporting is hard to do, differing team values, and feeling devalued and unsupported. CONCLUSION: The findings highlight the importance of understanding the ethical tensions faced by new graduates and of exploring ways to assist new graduates to respond constructively to ethical dilemmas, distress and uncertainties. To address the risk of attrition, graduates need systems in place for accessing support to increase preparedness to respond to ethical tensions when they do arise.
Subject(s)
Clinical Competence/standards , Occupational Therapists/psychology , Occupational Therapy/ethics , Occupational Therapy/standards , Female , Humans , Interviews as Topic , Job Satisfaction , Male , Narration , Qualitative Research , Young AdultABSTRACT
Purpose: Ethics education is a critical component of training rehabilitation practitioners. There is a need for capacity-building among ethics educators regarding facilitating ethical decision-making among students. The purpose of this study was to evaluate the utility of an on-line ethics education module for occupational therapy clinician-educators (problem-based learning tutors/clinical placement preceptors/evidence-based practice facilitators).Method: The Knowledge-to-Action Process informed development and evaluation of the module. Clinician-educators (n = 33) viewed the module and reported on its impact on knowledge and facilitation practices via pre, post, and follow-up questionnaires.Results: Pre- and post-test data indicated improvement in self-reported ethics knowledge (t = 8.275, p < 0.01). Follow-up data indicated knowledge did not decrease over time (t = -1.483, p = 0.075). There was improvement in self-reported intent to change practice (t = 4.93, p < 0.01); however, actual practice change was not indicated (t = -1.499, p = 0.072).Conclusion: This study provides preliminary data regarding an on-line ethics education module for clinician-educators. Future recommendations include broader consideration of context, adding supplemental knowledge translation components, and further research exploring outcomes with larger samples, longer follow-up and randomized trial methodology.Implications for RehabilitationThe on-line ethics module has potential to improve rehabilitation practice by addressing the noted gap in knowledge among clinician-educators.Viewing an on-line module regarding approaches to ethics education may not be sufficient to change clinician-educators' teaching practices.More time and opportunities to discuss ethics with student occupational therapists may be required to effect practice change among clinician-educators.Developing ethics education tools for clinician-educators requires ongoing and iterative input from knowledge users to optimize translation of ideas to practice.
Subject(s)
Education, Distance/methods , Ethics, Professional/education , Multimedia , Occupational Therapy , Rehabilitation , Curriculum , Humans , Occupational Therapy/education , Occupational Therapy/ethics , Rehabilitation/education , Rehabilitation/ethics , Surveys and Questionnaires , Teacher Training/methods , TeachingSubject(s)
Codes of Ethics/legislation & jurisprudence , Ethics, Professional , Guideline Adherence/ethics , Occupational Therapy/ethics , Occupational Therapy/standards , Professional Role , Guidelines as Topic , Humans , Occupational Therapy/legislation & jurisprudence , Societies, Medical , United StatesABSTRACT
UNLABELLED: The legislative developments that led to the Three-year Degree of the Health Professions poses any health professional in the position of having to comply with the ethical and legal duty to obtain valid informed consent from the patient prior to treatment. In the present work, attention was focused on the figure of the occupational therapist. MATERIALS AND METHODS: Informed consent forms have been developed according to the specific disease from which the patient undergoing occupational therapy is affected. The following categories of sick were identified: amputation, developmental age, orthopedy, spinal cord injury, neurology, psychiatry, geriatry and oncology. RESULTS AND CONCLUSION: The consent forms are particularly well suited to obtaining valid consent from the patient and, at the same time, allow the occupational therapist to obtain all the information he/she needs to carry out the treatment in safety. This results improved patient compliance to therapy by facilitating a better empathic relationship with the therapist.
Subject(s)
Informed Consent/ethics , Occupational Therapy/ethics , Patient Compliance , Physical Therapy Modalities/ethics , Adult , Amputation, Surgical/rehabilitation , Empathy/ethics , Geriatrics/ethics , Humans , Informed Consent/legislation & jurisprudence , Italy , Medical Oncology/ethics , Neurology/ethics , Occupational Therapy/legislation & jurisprudence , Orthopedics/ethics , Physical Therapy Modalities/legislation & jurisprudence , Psychiatry/ethics , Spinal Cord Injuries/rehabilitationABSTRACT
Background In Denmark patients are entitled to rehabilitation regardless of socio-economic status (SES). During this process therapists have to balance cost effectiveness with providing equal treatment. Aim To investigate whether occupational therapists and physiotherapists were influenced by the patient's SES. Material and method An experimental factorial vignette survey was used. Four different vignettes describing fictitious patient cases with different SES variables were randomly allocated to therapists working in somatic hospitals. Thereafter, the therapists judged specific clinical situations and general attitudes in relation to the patient's SES. Chi-square was used to test the statistical association between the variables. Results No statistically significant associations were found between the specific clinical situations and the patient's SES. A statistical significant association was found between general attitudes and the patient's SES. Subgroup analysis revealed a statistically significant association between the therapist's gender, age, and the therapeutic judgement in relation to SES. Conclusion In the specific clinical situations, Danish therapists seem to maintain their professional ethical principles, although they might face ethical dilemmas during their clinical decision-making. In order to prevent and resolve these dilemmas, they have to be made explicit. However, further research on how SES influences the health care professional's judgement is warranted.
Subject(s)
Attitude of Health Personnel , Clinical Decision-Making/ethics , Occupational Therapy/ethics , Physical Therapy Specialty/ethics , Social Class , Adult , Age Factors , Aged , Denmark , Educational Status , Employment , Female , Humans , Male , Middle Aged , Occupational Therapy/psychology , Professional-Patient Relations , Stroke Rehabilitation/ethics , Young AdultABSTRACT
PURPOSE: Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods. METHOD: Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation. RESULTS: Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important. CONCLUSION: The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.
Subject(s)
Ethics, Medical/education , Occupational Therapy/ethics , Physical Therapists/ethics , Rehabilitation/education , Rehabilitation/ethics , Canada , Curriculum , Female , Humans , Male , Occupational Therapy/education , Physical Therapists/education , Professional Competence , Self-Assessment , TeachingABSTRACT
INTRODUCTION: The term professionalism is embedded within curriculum and occupational therapy documents, yet, explicit discussion of the concept is lacking in the literature. This paper strives for a greater understanding of how professionalism is currently conceptualised within Western occupational therapy literature. METHODS: A broad literature search was conducted and included international peer-reviewed and grey literature from Western cultures including Australia, Canada, New Zealand, the United Kingdom and the United States. To enrich understanding, some documents from medicine were also included. FINDINGS: Professionalism is widely upheld as a core construct of occupational therapy. However, an evidence-based consensus of the specific elements of professionalism guiding occupational therapy practice is lacking. Currently, understanding of professionalism is largely based on multiple, isolated concepts presented in Western professional association documents. RELEVANCE TO CLINICAL PRACTICE: Acknowledging the multifaceted and multicultural nature of professionalism is essential to begin systematically delineating and conceptualising elements of professionalism specific to occupational therapy. LIMITATIONS: This review has been conducted from a solely Western cultural lens. RECOMMENDATIONS FOR FURTHER RESEARCH: Additional work to highlight differences specific to international contexts, cultures, and societal influences is needed to enrich the understanding of professionalism in occupational therapy practice.
Subject(s)
Occupational Therapy/organization & administration , Professionalism/standards , Australia , Behavior , Clinical Competence , Communication , Cooperative Behavior , Humans , Leadership , New Zealand , North America , Occupational Therapy/ethics , Occupational Therapy/standards , Professional Practice , Professionalism/ethics , United KingdomSubject(s)
Cultural Competency , Health Services, Indigenous/organization & administration , Human Rights , Native Hawaiian or Other Pacific Islander , Occupational Therapy/organization & administration , Australia , Health Services, Indigenous/ethics , Health Services, Indigenous/standards , Humans , Occupational Therapy/ethics , Occupational Therapy/standardsABSTRACT
AIM: A critical analysis of occupational therapy practice in the corporate health care culture in a free market economy was undertaken to demonstrate incongruence with the profession's philosophical basis and espoused commitment to client-centred practice. FINDINGS: The current practice of occupational therapy in the reimbursement-driven practice arena in the United States is incongruent with the profession's espoused philosophy and values of client-centred practice. Occupational therapy differentiates itself from medicine's expert model aimed at curing disease and remediating impairment, by its claim to client-centred practice focused on restoring health through occupational enablement. Practice focused on impairment and function is at odds with the profession's core tenet, occupation, and minimizes the lasting impact of interventions on health and well-being. The profession cannot unleash the therapeutic power of human occupation in settings where body systems and body functions are not occupation-ready at the requisite levels for occupational participation. CONCLUSION: Client-centred practice is best embodied by occupation-focused interventions in the natural environment of everyday living. Providing services that are impairment-focused in unfamiliar settings is not a good fit for client-centred practice, which is the unique, authentic, and sustainable orientation for the profession.
Subject(s)
Occupational Therapy , Patient-Centered Care , Professional Practice , Commerce , Delivery of Health Care , Humans , Occupational Therapy/ethics , Occupations , United StatesABSTRACT
PURPOSE: The purpose of this study was to examine current approaches and challenges to teaching ethics in entry-level Canadian physiotherapy (PT) and occupational therapy (OT) programs. METHODS: Educators responsible for teaching ethics in the 28 Canadian PT and OT programs (n = 55) completed an online survey. RESULTS: The quantity of ethics teaching is highly variable, ranging from 5 to 65 h. Diverse obstacles to ethics teaching were reported, relating to the organization and structure of academic programs, student issues and the topic of ethics itself. Specific challenges included time constraints, large class sizes, a lack of pedagogical tools adapted to teaching this complex subject, a perceived lack of student interest for the subject and a preference for topics related to clinical skills. Of note, 65% of ethics educators who participated in the survey did not have any specialized training in ethics. CONCLUSION: Significant cross-program variation in the number of hours dedicated to ethics and the diversity of pedagogical methods used suggests that there is little consensus about how best to teach ethics. Further research on ethics pedagogy in PT and OT programs (i.e. teaching and evaluation approaches and effectiveness of current ethics teaching) would support the implementation of more evidence-based ethics education. Implications for Rehabilitation Ethics educators in Canadian PT and OT programs are experimenting with diverse educational approaches to teach ethical reasoning and decision-making to students, including lectures, problem-based learning, directed readings, videos, conceptual maps and clinical elective debriefing, but no particular method has been shown to be more effective for developing ethical decision-making/reasoning. Thus, research on the effectiveness of current methods is needed to support ethics educators and programs to implement evidence-based ethics education training. In our survey, 65% of ethics educators did not have any specialized training in ethics. Ensuring that educators are well equipped to support the development of necessary theoretical and applied competencies can be promoted by initiatives including the creation of tailored ethics teaching and evaluation tools, and by establishing communities of practice among ethics educators. This survey identified heterogeneity in ethics teaching content, format and duration, and location within the curriculum. In order to be able to assess more precisely the place accorded to ethics teaching in PT and OT programs, careful mapping of ethics content inside and across rehabilitation programs is needed - both in Canada and internationally. These initiatives would help advance understanding of ethics teaching practices in rehabilitation.
Subject(s)
Curriculum/standards , Occupational Therapy/ethics , Physical Therapy Modalities/ethics , Teaching/standards , Canada , Humans , Internet , Occupational Therapy/education , Physical Therapy Modalities/education , Surveys and QuestionnairesABSTRACT
Life Capability is the first and most fundamental of Nussbaum's 10 Central Human Functional Capabilities (CHFCs). This capability refers to a person having a quality life of normal duration. The purpose of this study was to explore the views' of occupational therapists about Life Capability, specifically, their perspectives of this capability and its perceived relevance to practice. Semi-structured interviews with 14 occupational therapists in British Columbia, Canada, were conducted and thematically analyzed. Within this Canadian context, three themes emerged regarding occupational therapists' views about Life Capability: basic human right, quality of life, and longevity. Occupational therapists appear to view Life Capability as being consistent with the values of the occupational therapy profession. Nussbaum's other CHFCs warrant study to explore the degree to which the Capabilities Approach could complement existing occupational therapy theories, science, and practice.
Subject(s)
Attitude of Health Personnel , Human Rights/psychology , Occupational Therapists/psychology , Occupational Therapy/psychology , Quality of Life , Adult , Aptitude , British Columbia , Disability Evaluation , Female , Humans , Male , Middle Aged , Occupational Therapy/ethics , Qualitative ResearchABSTRACT
BACKGROUND: Values are evident in health ethics literature; however, it is seldom clear how they are visible in practice. PURPOSE: The aim of this study was to illuminate how values inform occupational therapists' decision making in practice. METHOD: Fifteen New Zealand community occupational therapists completed this embedded experimental mixed-methods study. A pre-deliberation questionnaire was completed prior to deliberation of a case study using web-based values transparency software, the Values Exchange, followed by a post-deliberation questionnaire. Categorical data were analyzed using non-parametric statistics. Written responses to open questions were thematically analyzed. FINDINGS: Most participants disagreed with the proposed action for the case. Degrees of divergence, concern for dignity and risk, and values-based reasoning were found, revealing how ethical deliberation was values based. IMPLICATIONSs. Recognition and transparency of the values inherent in practice-based decision making is possible and desirable in promoting sound ethical reasoning.
Subject(s)
Decision Making , Evidence-Based Practice/ethics , Occupational Therapy/ethics , Social Values , Data Interpretation, Statistical , Ethics, Professional , Female , Humans , New Zealand , Surveys and QuestionnairesABSTRACT
This study used a quantitative survey design to investigate the existence of moral distress among occupational therapists. The Moral Distress Scale-Revised (MDS-R-OHPA) was distributed to a random sample of 600 members of the American Occupational Therapy Association (AOTA). The results of this explorative study found that occupational therapists reported moderate levels of moral distress with occupational therapists working in geriatric settings reporting higher levels of moral distress than occupational therapists who work in physical disability settings, although the difference was not statistically significant. However, occupational therapists who were considering leaving their current position reported the highest levels of moral distress. These initial findings are discussed as well as the need for further research.
Subject(s)
Conflict, Psychological , Health Personnel/psychology , Morals , Occupational Therapy/psychology , Stress, Psychological/etiology , Work/psychology , Adult , Data Collection , Disabled Persons , Female , Geriatrics , Health Personnel/ethics , Humans , Male , Middle Aged , Occupational Therapy/ethics , Surveys and Questionnaires , Work/ethicsABSTRACT
As part of an expert panel convened to examine evidence and practice related to diverse aspects of driving evaluation and rehabilitation, consensus statements were developed on ethics. This paper provides context for the ethical obligation of practitioners to assess and make recommendations about the ability of clients to safely perform the activity of driving. It highlights key articles from the literature as well as principles from the Occupational Therapy Code of Ethics and Ethics Standards (2010). The statements support the importance of identifying impairments affecting driving, which could result in harm to the client as well as to the public. The ethical and professional obligation of practitioners to evaluate, make recommendations, and possibly report and/or refer to a driver rehabilitation specialist for further services is reinforced.